Sex differences in the associations among psychological factors and pain report: a novel psychophysical study of patients with chronic low back pain
Open accessAbstract
Unlabelled Previous studies have consistently suggested that there are sex differences in pain report, but there is no consensus regarding sex differences in the associations among psychological factors and pain report. This cross-sectional study used a novel, clinically relevant, psychophysical pain-induction technique to examine sex differences between sensory and affective pain report and sex differences in the association of depression, pain related anxiety, and catastrophizing with pain report. Patients with chronic low back pain (N = 53) were recruited from an outpatient spine clinic, and those consenting completed self-report measures of pain-related anxiety, depression, pain catastrophizing, and pain. A measure of induced low back pain was obtained by having study participants perform a protocol on the MedXtrade mark Low-Back Exercise Apparatus. Our results indicated that no sex differences were detected in psychological factors and self-reported or induced low back pain. However, the relationships between pain related anxiety and self-report of low back pain (z = 2.51, P < .05) and between pain-related anxiety and induced low back pain (z = 3.00, P < .05) were significantly stronger in men than women. These findings suggest that anxiety was linked to self-reported and induced low back pain for men, but not for women.Perspective Results of this study suggest that pain-related anxiety has a stronger association with psychophysical and clinical reports of low back pain for men.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a study of persistent orofacial pain, baseline catastrophizing was more than one standard deviation higher in non-responders than in responders.
“In a study aimed at identifying predictors of treatment responders for persistent orofacial pain, researchers found that baseline levels of catastrophizing were more than one standard deviation higher in the non-responder group than for responders 316.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [316]
Cites
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696 · see citing works
The McGill Pain Questionnaire: Major properties and scoring methods
Melzack, R. (1975) · Pain · doi:10.1016/0304-3959(75)90044-5 · Cited by 6,873 · see citing works
Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.
Vlaeyen, J. W. S., & Linton, S. J. (2000) · Pain · doi:10.1016/s0304-3959(99)00242-0 · Cited by 4,931 · see citing works
Rosenstiel, A. K., & Keefe, F. J. (1983) · Pain · doi:10.1016/0304-3959(83)90125-2 · Cited by 2,314 · see citing works
Crombez, G., Vlaeyen, J. W. S., Heuts, P. H. T. G., & Lysens, R. (1999) · Pain · doi:10.1016/s0304-3959(98)00229-2 · Cited by 1,662 · see citing works
Pincus, T., Burton, A. K., Vogel, S., & Field, A. P. (2002) · Spine · doi:10.1097/00007632-200203010-00017 · Cited by 1,633 · see citing works
Gender variations in clinical pain experience
Unruh, A. M. (1996) · Pain · doi:10.1016/0304-3959(95)00214-6 · Cited by 1,550 · see citing works
Price, D. D., Bush, F. M., Long, S., & Harkins, S. W. (1994) · Pain · doi:10.1016/0304-3959(94)90097-3 · Cited by 1,174 · see citing works
Berkley, K. J. (1997) · Behavioral and Brain Sciences · doi:10.1017/s0140525x97221485 · Cited by 1,125 · see citing works
Sex differences in the perception of noxious experimental stimuli: a meta-analysis
Riley, J. L., Robinson, M. E., Wise, E. A., Myers, C. D., & Fillingim, R. B. (1998) · Pain · doi:10.1016/s0304-3959(97)00199-1 · Cited by 1,085 · see citing works
PSYCHOMETRIC PROPERTIES OF THE BECK DEPRESSION INVENTORY
Richter, P., Hseerlein, A., Kick, H., & Biczo, P. (1994) · IX World Congress of Psychiatry · doi:10.1142/9789814440912_0055 · Cited by 885 · see citing works
Pain Measurement and Assessment
Melzack, R. (1983) · Medical Entomology and Zoology · Cited by 575 · see citing works
Melzack, R., & Raja, S. N. (2005) · Anesthesiology · doi:10.1097/00000542-200507000-00028 · Cited by 484 · see citing works
Gender differences in the responses to noxious stimuli
Fillingim, R. B., & Maixner, W. D. (1995) · Pain Forum · doi:10.1016/s1082-3174(11)80022-x · Cited by 475 · see citing works
Self-citationGender role expectations of pain: relationship to sex differences in pain
Robinson, M. E., Riley, J. L., Myers, C. D., Papas, R. K., Wise, E. A., Waxenberg, L. B., & Fillingim, R. B. (2001) · The Journal of Pain · doi:10.1054/jpai.2001.24551 · Cited by 423 · see citing works
Self-citationPain measurement and assessment
Pearce, S. (1984) · Pain · doi:10.1016/0304-3959(84)90089-7 · Cited by 360 · see citing works
The McGill Pain Questionnaire: Appraisal and current status.
Melzack, R., & Katz, J. D. (2001) · Cited by 350 · see citing works
Proceedings of the 7th World Congress on Pain
Korevaar, W. C. (1995) · Clinical Journal of Pain · doi:10.1097/00002508-199509000-00017 · Cited by 320 · see citing works
Sex differences in temporal summation but not sensory-discriminative processing of thermal pain
Fillingim, R. B., Maixner, W., Kincaid, S., & Silva, S. (1998) · Pain · doi:10.1016/s0304-3959(97)00214-5 · Cited by 289 · see citing works
Self-citationGender Differences in Pain and Pain Behavior: The Role of Catastrophizing
Sullivan, M. J. L., Tripp, D. A., & Santor, D. (2000) · Cognitive Therapy and Research · doi:10.1023/a:1005459110063 · Cited by 285 · see citing works
Correlates of improvement in multidisciplinary treatment of chronic pain.
Jensen, M. P., Turner, J. A., & Romano, J. M. (1994) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.62.1.172 · Cited by 280 · see citing works
Fillingim, R. B. (2017) · Principles of Gender-Specific Medicine · doi:10.1016/b978-0-12-803506-1.00038-3 · Cited by 255 · see citing works
Self-citationThe Coping Strategies Questionnaire: A Large Sample, Item Level Factor Analysis
Robinson, M. E., Riley, J. L., Myers, C. D., Sadler, I. J., Kvaal, S. A., Geisser, M. E., & Keefe, F. J. (1997) · The Clinical Journal of Pain · doi:10.1097/00002508-199703000-00007 · Cited by 254 · see citing works
Self-citationThe assessment of anxiety and fear in persons with chronic pain: A comparison of instruments
Mccracken, L. M., Gross, R. T., Aikens, J., & Carnrike, C. L. M. (1996) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(96)00057-5 · Cited by 232 · see citing works
Cross-modality matching functions generated by magnitude estimation
Stevens, J. C., & Marks, L. E. (1980) · Perception & Psychophysics · doi:10.3758/bf03204456 · Cited by 194 · see citing works
Influences of gender role and anxiety on sex differences in temporal summation of pain
Robinson, M. E., Wise, E. A., Gagnon, C., Fillingim, R. B., & Price, D. D. (2004) · The Journal of Pain · doi:10.1016/j.jpain.2003.11.004 · Cited by 193 · see citing works
Self-citationAnalysis of gender effects on pain perception and symptom presentation in temporomandibular pain
Bush, F. M., Harkins, S. W., Harrington, W. G., & Price, D. D. (1993) · Pain · doi:10.1016/0304-3959(93)90058-w · Cited by 188 · see citing works
Sex differences in pain perception and anxiety. A psychophysical study with topical capsaicin
Frot, M., Feine, J. S., & Bushnell, C. M. (2004) · Pain · doi:10.1016/j.pain.2003.11.017 · Cited by 171 · see citing works
Gender differences in temporal summation of mechanically evoked pain
Sarlani, E., & Greenspan, J. D. (2002) · Pain · doi:10.1016/s0304-3959(02)00015-5 · Cited by 171 · see citing works
Hiscock, M., Inch, R., Hawryluk, J., Lyon, P. J., & Perachio, N. (1994) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688639508405148 · Cited by 161 · see citing works
Depression in chronic pain patients: Relation to pain, activity, and sex differences
Haley, W. E., Turner, J. A., & Romano, J. M. (1985) · Pain · doi:10.1016/0304-3959(85)90003-x · Cited by 139 · see citing works
Sarlani, E., Grace, E. G., Reynolds, M. A., & Greenspan, J. D. (2004) · Pain · doi:10.1016/j.pain.2004.01.019 · Cited by 132 · see citing works
Gender and laterality differences in thermosensation throughout the perceptible range
Sarlani, E., Farooq, N. S., & Greenspan, J. D. (2003) · Pain · doi:10.1016/s0304-3959(03)00211-2 · Cited by 125 · see citing works
Riley, J. L., & Robinson, M. E. (1997) · Clinical Journal of Pain · doi:10.1097/00002508-199706000-00010 · Cited by 124 · see citing works
Self-citationA Comparison of Fear-Avoidance Beliefs in Patients With Lumbar Spine Pain and Cervical Spine Pain
George, S. Z., Fritz, J. M., & Erhard, R. E. (2001) · Spine · doi:10.1097/00007632-200110010-00019 · Cited by 119 · see citing works
Self-citationThe Effect of Anxiety Sensitivity and Gender on the Experience of Pain
Keogh, E., & Birkby, J. (1999) · Cognition & Emotion · doi:10.1080/026999399379096 · Cited by 117 · see citing works
Modulation of myofascial pain by the reproductive hormones: A preliminary report
Dao, T. T. T., Knight, K., & Ton-That, V. (1998) · Journal of Prosthetic Dentistry · doi:10.1016/s0022-3913(98)70073-3 · Cited by 114 · see citing works
The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning
Strahl, C., Kleinknecht, R. A., & Dinnel, D. L. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00102-3 · Cited by 111 · see citing works
Hiscock, M., Inch, R., Jacek, C., et al. (1994) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688639408402653 · Cited by 103 · see citing works
The Pain Anxiety Symptoms Scale: Psychometric properties in a community sample
Osman, A., Barrios, F. X., Osman, J. R., Schneekloth, R., & Troutman, J. A. (1994) · Journal of Behavioral Medicine · doi:10.1007/bf01857923 · Cited by 102 · see citing works
Sex-specific effects of pain-related anxiety on adjustment to chronic pain
Edwards, R., Augustson, E. M., & Fillingim, R. (2000) · The Clinical Journal of Pain · doi:10.1097/00002508-200003000-00008 · Cited by 98 · see citing works
Self-citationDifferences between the sexes in post-surgical pain☆
Morin, C., Lund, J. P., Villarroel, T., Clokie, C. M. L., & Feine, J. S. (2000) · Pain · doi:10.1016/s0304-3959(99)00248-1 · Cited by 94 · see citing works
Dispositional anxiety and the experience of pain: gender‐specific effects
Jones, A., Zachariae, R. H., & Arendt‐Nielsen, L. (2003) · European Journal of Pain · doi:10.1016/s1090-3801(02)00139-8 · Cited by 91 · see citing works
LINTON, S. J., & Ryberg, M. (2000) · European Journal of Pain · doi:10.1053/eujp.2000.0190 · Cited by 82 · see citing works
Validity of the Pain Anxiety Symptoms Scale (PASS): prediction of physical capacity variables
Burns, J. W., Mullen, J. T., Higdon, L. J., Wei, J. M., & Lansky, D. (2000) · Pain · doi:10.1016/s0304-3959(99)00218-3 · Cited by 73 · see citing works
Sex Differences in Clinical Pain: A Multisample Study
Robinson, M. E., Wise, E. A., Riley, J. L., & Atchison, J. W. (1998) · Journal of Clinical Psychology in Medical Settings · doi:10.1023/a:1026282210848 · Cited by 65 · see citing works
Self-citationLarsen, D. K., Taylor, S., & Asmundson, G. J. G. (1997) · Pain · doi:10.1016/s0304-3959(96)03232-0 · Cited by 61 · see citing works
Edwards, R. R., Augustson, E. M., & Fillingim, R. B. (2003) · Clinical Journal of Pain · doi:10.1097/00002508-200307000-00003 · Cited by 55 · see citing works
Self-citationPsychological Correlates of Pain Behavior in Patients With Chronic Low Back Pain
Dickens, C. M., Jayson, M. I. V., & Creed, F. H. (2002) · Psychosomatics · doi:10.1176/appi.psy.43.1.42 · Cited by 53 · see citing works
Jones, D. A., Rollman, G. B., White, K. P., Hill, M. L., & Brooke, R. I. (2003) · Journal of Pain · doi:10.1016/s1526-5900(03)00630-8 · Cited by 50 · see citing works
Effects of Gender and Acute Dental Pain on Thermal Pain Responses
Edwards, R. R., Fillingim, R. B., Yamauchi, S., Sigurðsson, Á., Bunting, S., Mohorn, S., & Maixner, W. D. (1999) · Clinical Journal of Pain · doi:10.1097/00002508-199909000-00011 · Cited by 46 · see citing works
Self-citationFavaretto, E., Torresani, S., & Zimmermann, C. (2000) · Journal of Clinical Psychology · doi:10.1002/1097-4679(200101)57:1 · Cited by 41 · see citing works
Assessing the dimensions of pain: a multitrait-multimethod evaluation of seven measures
Holroyd, K. A., Talbot, F., Holm, J. E., Pingel, J. D., Lake, A. E., & Saper, J. R. (1996) · Pain · doi:10.1016/0304-3959(96)03129-6 · Cited by 34 · see citing works
Psychological distress and disability in back pain patients: Evidence of sex differences
Bolton, J. E. (1994) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(94)90072-8 · Cited by 32 · see citing works
McCracken, L. M., & Houle, T. T. (2000) · Clinical Journal of Pain · doi:10.1097/00002508-200009000-00016 · Cited by 21 · see citing works
Use of magnitude matching for measuring group differences in pain perception
Duncan, G. H., Feine, J. S., Bushnell, M. C., & Boyer, M. (1987) · Pain · doi:10.1016/0304-3959(87)91103-1 · Cited by 16 · see citing works
Fuller, A. K., & Robinson, M. E. (1995) · Behavior Therapy · doi:10.1016/s0005-7894(05)80104-2 · Cited by 11 · see citing works
Self-citationCoping and catastrophizing in chronic pain: A psychometric analysis and comparison of two measures1
Stewart, M. W., Harvey, S. T., & Evans, I. M. (2003) · Journal of Clinical Psychology · doi:10.1002/jclp.10227 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Sex, gender, and pain: a review of recent clinical and experimental findings
Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley, J. L. (2009) · The Journal of Pain · doi:10.1016/j.jpain.2008.12.001 · Cited by 2,766 · see citing works
Self-citationEvaluating psychosocial contributions to chronic pain outcomes
Meints, S. M., & Edwards, R. R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.01.017 · Cited by 719 · see citing works
Psychological processing in chronic pain: a neural systems approach
Simons, L. E., Elman, I., & Borsook, D. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.12.006 · Cited by 359 · see citing works
The perception of pain in others: how gender, race, and age influence pain expectations
Wandner, L. D., Scipio, C. D., Hirsh, A. T., Torres, C. A., & Robinson, M. E. (2012) · The Journal of Pain · doi:10.1016/j.jpain.2011.10.014 · Cited by 263 · see citing works
Self-citationStubbs, D., Krebs, E., Bair, M., Damush, T., Wu, J., Sutherland, J., & Kroenke, K. (2010) · Pain Medicine · doi:10.1111/j.1526-4637.2009.00760.x · Cited by 170 · see citing works
Martinez-Calderon, J., Flores-Cortes, M., Morales-Asencio, J. M., & Luque-Suarez, A. (2019) · The Journal of Pain · doi:10.1016/j.jpain.2019.04.009 · Cited by 141 · see citing works
Symptom Prevalence and Clustering of Symptoms in People Living with Chronic Hepatitis C Infection
Lang, C. A., Conrad, S., Garrett, L., Battistutta, D., Cooksley, W. G. E., Dunne, M. P., & Macdonald, G. A. (2006) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2005.08.016 · Cited by 99 · see citing works
Overview of orofacial pain: epidemiology and gender differences in orofacial pain
Shinal, R. M., & Fillingim, R. B. (2007) · Dental Clinics of North America · doi:10.1016/j.cden.2006.09.004 · Cited by 80 · see citing works
Self-citation
- Authors
- Robinson, M. E., Dannecker, E. A., George, S. Z., Otis, J., Atchison, J. W., & Fillingim, R. B.
- Affiliations
- University of Florida Health (US)
- University of Missouri (US)
- VA Boston Healthcare System (US)
- University of Florida (US)
- Corresponding author
- Robinson, Michael E.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2005-07
- Volume
- 6
- Issue
- 7
- Pages
- 463-470
- ISSN
- 1526-5900 (ISSN-L)
- OpenAlex
- W2140422243
- Cited by
- 64
- References
- 58
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 3 · 2014: 4 · 2013: 2 · 2012: 6
- FWCI
- 2.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r15mh057131-01a1)
- National Institute of Mental Health (R15MH57131)
- National Institute of Dental and Craniofacial Research (1RO1 DE 13208-01A2, R01DE013208)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- sex differences, chronic low back pain, pain-related anxiety, depression, pain catastrophizing, pain perception
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anxiety Disorders, Chronic Disease, Cross-Sectional Studies, Depressive Disorder, Female, Humans, Male, Middle Aged, Pain Measurement, Psychology, Psychophysiologic Disorders, Sex Characteristics, Exercise Tolerance, Low Back Pain, Pain Threshold
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review